Early stress hyperglycemia as independent predictor of increased mortality in preterm infants

Abstract

Purpose : Stress hyperglycemia is common in critically ill adult patients. It is known as a predictor of increased mortality and intensive insulin therapy has been shown to improve the prognosis in such patients. We have investigated the relationship between early stress hyperglycemia and clinical outcomes in preterm infants. Methods : In this study 141 preterm infants with a gestational age of less than 30 weeks were enrolled. The hyperglycemic group was defined as that having maximum glucose of more than 150 mg/dL (n=61 during the first 48 h of life and the non-hyperglycemic group was defined as that having maximum glucose of less than 150 mg/dL (n=80. Perinatal history severity of illness using the Clinical Risk Index for Babies (CRIB score clinical outcomes and mortality of the two groups were compared. Results : There was no significant difference in the gestational age between the two groups but the birth weight (P<0.001 was significantly lower and the CRIB score (P<0.001 was significantly higher in the hyperglycemic group. Disseminated intravascular coagulation (P<0.001 and clinically suspected sepsis (P=0.046 were more common in the hyperglycemic group. Mortality was markedly higher in the hyperglycemic group (11.3% vs. 41.0% P<0.001. On performing a stepwise multiple logistic regression analysis hyperglycemia (OR 3.787; 95% CI 1.324 to 10.829 the CRIB score (OR 1.252; 95% CI 1.047 to 1.496 and birth weight (OR 0.997; 95% CI 0.994 to 1.000 was independently associated with higher mortality. Conclusion : Stress hyperglycemia within the first 48 h of life is independently related to increased morbidity and mortality in preterm infants. (Korean J Pediatr 2007;51:474-480